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# HIV and the mouth

- Mouth and systemic disease

Oral lesions can be the first sign of HIV and a marker of falling immunity. Thrush, hairy leukoplakia and necrotising gum disease are the classic ones.

Updated Nov 12, 2026

## Key points

- Thrush, hairy leukoplakia and necrotising gum disease suggest HIV.
- Purple palatal lesion: think of Kaposi sarcoma.
- Offer an HIV test when these appear.

## What it is

Oral lesions are common in untreated HIV infection and often appear when CD4 counts fall. Some are strongly associated with HIV: candidiasis (pseudomembranous and erythematous), oral hairy leukoplakia (white corrugated plaques on the lateral tongue caused by Epstein–Barr virus), necrotising gingivitis and periodontitis, Kaposi sarcoma (purple macules or nodules, often on the palate or gums) and non-Hodgkin lymphoma. Others include recurrent or severe herpes, large aphthous-like ulcers, warts from human papillomavirus, parotid enlargement and dry mouth. Effective antiretroviral therapy has made most of these less frequent.

## Oral findings

- Strongly associated: candidiasis, hairy leukoplakia, necrotising periodontal disease, Kaposi sarcoma, lymphoma.
- Hairy leukoplakia does not wipe off and is usually painless.
- Kaposi sarcoma: red-purple flat or raised lesions, commonly on the hard palate.
- Oral warts and salivary gland disease can increase even on antiretroviral therapy.
- Oral lesions in a person on treatment can signal treatment failure or poor adherence.

## What the doctor does

- Any of these lesions in a person of unknown status is an indication to offer an HIV test.
- Large, persistent ulcers need biopsy to exclude lymphoma, cytomegalovirus or other infections.
- Dental care can and should be provided normally with standard infection-control precautions.

## Next step / Initial management

- Offer an HIV test with consent to anyone with a suggestive oral lesion; refer positive results to the HIV programme.
- Treat candidiasis and herpes; consider systemic antifungals for extensive disease.
- Purple or red lesions, persistent ulcers or masses: refer for biopsy.
- Refer to the dentist for regular care; standard precautions apply to all patients.

## Test yourself

Think of the answer, then tap the question to see it.

## Which virus causes oral hairy leukoplakia?

Epstein–Barr virus.

## Where does oral Kaposi sarcoma most often appear?

On the hard palate, and also on the gums.

## What should a suggestive oral lesion in a person of unknown HIV status prompt?

An offer of HIV testing with consent.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/dentistry/hiv-and-the-mouth/)

## Connections

## Related 4

- [Oral candidiasis (thrush)](https://durgical.com/en/dentistry/oral-candidiasis/)
- [White and red patches in the mouth: approach](https://durgical.com/en/dentistry/white-and-red-patches-in-the-mouth-approach/)
- [Necrotising gingivitis and periodontitis](https://durgical.com/en/dentistry/necrotising-gingivitis-and-periodontitis/)
- [Herpes in the mouth: primary gingivostomatitis and cold sores](https://durgical.com/en/dentistry/herpes-in-the-mouth-primary-gingivostomatitis-and-cold-sores/)

## Related conditions 1

- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)

## In Pharmacology 2

- [Fluconazole](https://durgical.com/en/pharmacology/fluconazole/)
- [Aciclovir](https://durgical.com/en/pharmacology/aciclovir/)

[← All of dentistry](https://durgical.com/en/dentistry/)

Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.

Sources: [HIV and AIDS](https://www.ncbi.nlm.nih.gov/books/NBK534860/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Hairy Leukoplakia](https://www.ncbi.nlm.nih.gov/books/NBK554591/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Fungal Infections of the Oral Mucosa](https://www.ncbi.nlm.nih.gov/books/NBK585050/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Viral Infections of the Oral Mucosa](https://www.ncbi.nlm.nih.gov/books/NBK585132/) (StatPearls Publishing (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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